Rules for pain Drs in TX

Discussion in 'Fibromyalgia Main Forum' started by Tizz, Nov 5, 2010.

  1. Tizz

    Tizz New Member

    If you read this you will get an idea of why pain Drs are under so much stress these days:


    Clinics must register with the state's medical board if 50 percent of their patients are prescribed controlled substances.

    Clinics must be owned by a Texas doctor who is present a third of the operating hours.

    Clinic owners cannot have committed a felony or drug-related misdemeanor.

    Clinic owners cannot have been subject to any disciplinary action by state or federal agencies involving controlled substances.

    Texas Medical Board has the right to inspect clinics to ensure rules are followed.

    Clinic owners must ensure proper medical protocol is followed and the staff is trained and qualified.

    Adequate records must be kept on costs and services to patients.

    Excluded from registration: education facilities, government-operated facilities, hospitals, hospices and clinics owned by doctors or nurse practitioners who use other treatments with the issuance of pain medications.

    Source: Texas Medical Board

  2. Tizz

    Tizz New Member

    Prescriptions for three "controlled substance" drugs together called the "Holy Trinity" (or a "Houston cocktail) have been linked to hundreds of overdose deaths, but the death rate dropped by a dramatic 45 percent around Houston during the first month that those stricter state regulations were in effect.

    ...Houston is one of three major U.S. areas where lots of fake prescriptions were being written for these 3 drugs — hydrocodone (painkiller), alprazolam ( anti-anxiety) and carisoprodol (muscle relaxant). When all 3 are taken together they can create a high almost like heroin.

    [This Message was Edited on 11/05/2010]
  3. justjanelle

    justjanelle New Member

    You said "the death rate dropped by a dramatic 45 percent around Houston during the first month that those stricter state regulations were in effect."

    I wonder if you have a source for this? I'd really like to see some data on it, because it does seem very dramatic -- in fact, too dramatic to be true.

    I used to do data analysis for the MN Dept of Health Statistics, and I do know a bit about death stats -- and even the complete elimination of all drug-related deaths would not cause the death rate to drop by 45%. You have to consider that many, many more deaths are caused by accidents, heart attacks, old age, cancers and other illnesses, and that only a very small percentage of deaths are drug-related.

    Even if the 45% drop figure was actually meant to mean a 45% drop in the number of drug-overdose deaths, that would still be unlikely, given the competition the pain med abusers would be under from the heroin, meth and crack/cocaine users.

    I suppose they could mean that there was a 45% drop in the overdose deaths *from these particular drugs* after the new rules went into effect....

    But from reading the rules themselves, I don't really see that these rules would lead to an immediate tightening of the supply of pain meds to the abusers. Over the long run? Maybe it would have an impact. But not this dramatically and not during the first month.

    (That said, I'm willing to be convinced if there is actual data to back it up.)

    Best wishes,
  4. Tizz

    Tizz New Member

    I didn't write the article and I didn't investigate their sources, but it's from an article in the Houston Chronicle by Cindy Horswell, called "Deadly drug trio meted out far less since law
    Prescriptions for 'Holy Trinity' drop by almost half in one month".

    Nov. 5, 2010

    You should be able to find it with that info.

    My comments are not verbatim, but they're based on what it said in that article. To quote the article:

    "overdose deaths dropped by a dramatic 45 percent in the Houston area during the first month that stricter state regulations took effect"

    I'm pretty sure the "death rate" referred to was the death rate from the Holy Trinity -- certainly not the overall death rate.
    [This Message was Edited on 11/06/2010]
  5. justjanelle

    justjanelle New Member

    The article says, "Prescriptions written for three addictive drugs linked to hundreds of overdose deaths dropped by a dramatic 45 percent in the Houston area during the first month that stricter state regulations took effect."

    That's in the first paragraph. Later in the article it says further, " September, Houston-area doctors wrote 6,143 prescriptions for the three drugs compared with 10,989 written during the same period a year earlier."

    The first paragraph is where the confusion occurs: She's saying that the number of prescriptions written for these addictive medications dropped 45%, and the numbers given later also reflect the 45% fewer prescriptions written.

    So while she mentions that these medications have caused "hundreds of overdose deaths" over some period in the past, she doesn't actually mention how much the lowered prescription numbers have affected number of overdose deaths.

    It would certainly make sense, of course, that with fewer of these prescriptions written the overdose death rate from them would come down. It may take some time to see clearly how *much* it comes down. (I wonder if the addicts who've been cut off by the pill-mill docs will now switch to heroin, meth or something else to get their high. I hope not, but it seems likely to me.)

    Thanks for following up on this and clarifying!

    Best wishes,
  6. Tizz

    Tizz New Member

    ...It was just an article I found in the paper, and I remembered I'd made a copy of those new rules, earlier.

    It sounds like those 3 drugs, together, are very dangerous. But of course, the "manner of delivery" may be IV, not oral, when they make a "Houston Cocktail" -- I'm not an expert on illegal drugs so I don't know.

    Every time I hear about something like this, it saddens me. Drug abusers are always finding new ways to pervert legitimate drugs into deadly and highly addictive concoctions. But drug abusers who overdose are not the only "victims" of concoctions like this "Holy Trinity".

    When drugs that are useful and beneficial to us are abused, it leads to ever-increasing restrictions that make it harder and harder for those who need them to get those drugs.

    And of course, it makes pain specialists and other doctors very, very nervous about prescribing controlled drugs, at all... especially opioids.

  7. Janalynn

    Janalynn New Member

    I don't think these rules are any different than any other state - or than what they should be I should say.

    All Drs should keep records, make sure they're staff are trained and qualified. I think it's okay that they should register with a medical board, have a Dr. present and should't be a felon.

    I am assuming these rules are for PAIN CLINICS. These are not for Dr.'s. Dr.s who prescribe in a practice are probably under their own set of rules, but I think their guidelines are just as strict.

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